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CRANIUMConcussion Recognition And Neurological Intervention United Management
What is a Concussion Mayo defines a concussion as:
“Traumatic brain injury that alters the way your brain functions”
http://www.mayoclinic.org/diseases-conditions/concussion/basics/definition/CON-20019272
CDC defines a concussion as: “Type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth”
http://www.cdc.gov/headsup/basics/concussion_whatis.html
Traumatic Brain Injuries (TBI) 75% of all TBI’s result from concussions or other forms of mild
TBI’s TBI’s can cause:
Epilepsy Parkinson's Alzheimer's
Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal
Chronic Traumatic Encephalopathy Newly identified disease associated with repeated concussions Release of a protein called TAU slowly kills brain cells Once started it appears to progress without further incident Only diagnosed after death
http://www.cdc.gov/HeadsUp/ http://concussionfoundation.org/learning-center/what-is-cte
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Concussion Prevalence Estimated 1.7-4.0 million occur each year 60-80% resolve in 7-10 days Up to 33% of individuals will have post
concussion syndrome Up to 30% of individuals will demonstrate
post concussion symptoms 6 months post injury
Kozlowski, K. F., Graham, J., Leddy, J. J., Devinney-Boymel, L., & Willer, B. S. (2013). Exercise intolerance in individuals with postconcussion syndrome. Journal of Athletic Training, 48(5), 627-635. doi:10.4085/1062-6050-48.5.02
Possibility of Becoming a Star 8 million student athletes compete at the high
school level 480,000 athletes compete at the collegiate level Less than 2% of college athletes play professional
sports http://www.ncaa.org/about/resources/research/estimated-probability-competing-college-athletics http://work.chron.com/likelihood-someone-becoming-professional-sports-player-26110.html
Signs & Symptoms Confusion Amnesia Headache Loss of consciousness Balance problems Blurry Vision Concentration/
memory problems
Sensitivity to light/noise
Nausea Feeling foggy, tired Feeling irritable Slowed reaction
time
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Concussion Management Protocol1. Athlete suspected of concussion is
immediately removed from field of play2. Athlete assessed by qualified health care
provider3. Referral to Physical Therapist or Athletic
Trainer4. Return to play progression completed5. Athlete referred to health care provider for
clearance to return to practice and then competition
Three Is Better Than One Sport Concussion Assessment Tool-3rd
Edition Vestibular Ocular Motor Screening Balke Treadmill Test
Sports Concussion Assessment Tool 3rd
Includes: Symptom evaluation, Cognitive & physical evaluation, Balance, Coordination, Recall, Memory Balance Error Scoring System
Broadly Normal: Score 1-4 Below Average: Score ≥ 5
Self reported symptom score of 24.91/122 compared to 6.53/122
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Vestibular Ocular Motor Screening (VOMS) Quick 5-10 minute test Provocation testing of the vestibular and
ocular motor systems Symptom changes are rated by patient 2014 American Journal of Sports Medicine
Scores ≥ 2 total symptoms after any VOMS item (96%) or a Near Point Convergence distance of ≥ 5 cm (84%) resulted in high rates of concussion identification.
Balke Treadmill Test Standardized treadmill protocol Test terminated due to fatigue or
production of concussion symptoms 2013 Journal of Athletic Training:
100% of patients with concussion stopped the test due to return of concussion symptoms.
Median exercise duration was 40% of the control group, 9 minutes or less compared to 18
Sensitivity 99% and Specificity 89%
Return to Play Protocol Consists of 5 phases each adding a plane
of movement and intensity Athletes 12 years old or younger- 72 hours
symptom free before progressions Athletes 13 years old and older- 24 hours
symptom free before progression http://www.cdc.gov/headsup/providers/return_to_activities.html
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Return to Play Phases Phase #1- No Activity
Complete physical and cognitive rest Symptom free x 24 hours progress to phase 2
Phase #2- Light Aerobic Exercise 20 min of cardiovascular exercise at less than 70% heart
rate max
Phase #3- Sport Specific Exercise 45min of cardiovascular less than 80% heart rate max
Phase #4 Non-Contact Training Drills 60min of complex training less than 90% of heart rate
max
Phase #5- Full Contact/Practice
Medical Clearance Between Stage 4 & 5:
Balke Treadmill Testing Normal SCAT-3 Normal VOMS
Medical Clearance to Return to Full Contact Practice Only
Symptom Free x 24 hours Clearance to Return to Competition
Medical Coverage MHSAA Insurance Benefit
Suspected concussion Grades 7-12 Receive prompt and professional attention
for head injuries Requires referral to Physical Therapy
services from qualified health care professional
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How to Improve the Health and Vitality of Your Community
Patrick Sustrich, MSChief Integration Officer/
Executive Director of AL!VE
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Old Mission
To provide personalized and affordable quality healthcare…
New MissionTo enhance the overall health and vitality of the
people and communities we serve.
Phase 1 - HUD Project Cost: $ 9.6 millionPhase 1 – non-HUD Project Cost: $ 2.7 millionPhase 2 Project Cost: $ 3.2 millionTotal Project Costs: $15.5 million
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Guiding Principles
Collaboration
vs.
Competition
Collaborators
8,000+ ProgramsPer Year!!
Local Collaborators
Charlotte Public Schools Eaton RESA
Charlotte Time Bank CrossFit Fade
CAN DO!/ Step by Step Charlotte Chamber
Eaton Area Senior Center Barry Eaton District Health Dept.
Charlotte Aquatic Center Linn Products
Gavel Restaurant Team One Chevrolet
Spartan Motors Eaton County Offices
Peckham Eaton Federal Bank
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Regional Collaborators
The Big Salad Michigan State University
Fenner Nature Center Sparrow Hospital
Impression 5 Science Center GLCVB
Eaton Conservation District Capital Area Health Alliance
LEAP BC/BS Michigan
Boy Scouts of America Community Partners in Health
Lansing Chamber YMCA
American Heart Association American Kidney Foundation
Olivet College PNC Bank
Guiding Principles
Accessible to ALL
Accessible to ALL
• 16,000+ L!NK Cardholders…
200,000+ Visits/ Year!!
In a community of 9,500 people…
coming from over 240 different zip codes!
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Fitness Membership Data
14%
L!NK Cardholder Data
38%
Guiding Principles
Regional Impact
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Regional Impact
• MHA Ludwig Community Benefit Award
• Lansing Regional Growth Award
• CAHA Health Advancement Award
• Alvin Whitfield Community Service Award
• GLCVB Be a Tourist Passport Participant
• PNC Grow-Up Great Grant
• Nature-A-Bounds Grant
• Joe D. Pentecost Grant
• BC/BS Winter Warm-Up Grant
• Generation E Grant
• Capital Regional Community Foundation Grants
Video Links
• Creative Well-Being: https://vimeo.com/105239043
• The Business Case: https://vimeo.com/105243154
• Design Experience: https://vimeo.com/105239042
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How to Improve the Health and Vitality of Your
Community
How to Improve the Health and Vitality of Your
Community
Questions
Guiding PrinciplesReturn on Investment
• By year 3, AL!VE should generate positive EBIDA
• After year 3, AL!VE operations should also contribute to debt obligation
• Long‐term payback of investment
AL!VE Financials
FY11 FY12 FY13 FY14 FY15 FY16
Net Revenue $3,152,408 $3,319,372 $3,944,678 $4,464,112 $4,839,142 $5,151,436
Expense $1,756,945 $2,440,432 $3,299,867 $3,418,825 $3,107,119 $3,210,953
Net Income $1,395,463 $878,940 $644,811 $1,045,286 $1,732,023 $1,940,483
EBIDA $1,466,815 $967,646 $803,265 $1,257,068 $1,968,119 $2,205,094
Incremental EBIDA
($499,169) ($663,550) ($209,747) $501,304 $738,279
33% AL!VE Phase 1
100% AL!VEPhase 1;
33% Phase 2
100% AL!VE Phase 1 & 2
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EBIDA
EBIDA